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Concepts for payer and plan on CDM Payer_Plan_Period table


#1

Hi there!

Would you please confirm or refuse my assumptions.
My questions are about plan and payer concepts populating depending from the type of plan value (planType) on Detail Enrollment table for Truven Health MarketScan Databases.

  1. When the type of plan is ‘8’ (CDHP) or ‘9’ (HDHP) then we populate the plan_concept_id with 267 (‘Catastrophic Health Plan with <60% actuarial plan value’), right?
    Would it be correct when populating plan_concept_id with 270 (‘Medical only plan’) where the type of plan on source Detail Enrollment table equal ‘1’ (Basic/major medical)?
    Exactly like that, would it be correct when populating plan_concept_id with 268 (‘Broad Benefit (Medical, Drug, Dental, Vision plan)’) where the type of plan on source Detail Enrollment table equal ‘2’ (Comprehensive)?
    Are these standard plan concepts proper in this context for Сommersial Claims and Encounters dataset, for Medicare dataset, for Medicaid datasets?

  2. The second question is about payer_concept_id populating.
    When the planType value equal ‘5’ (Point of Service) or ‘7’ (Point of Service with capitation) then we populate payer_concept_id with 331 (‘Commercial Managed Care - Point of Service’) and with 284 (‘Medicare Point of Service’) for Сommersial Claims and Encounters dataset and Medicare dataset correspondingly.
    I suppose that we can populate payer_concept_id with 433 (‘Managed Care POS’) for Medicaid dataset where source type of plan is ‘5’ or ‘7’, am I right or not?

Thank you in advance!
@MPhilofsky @Christian_Reich @Dymshyts @Gowtham_Rao @nzvyagina


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